Understanding Stress Fractures: Part 1

Stress fractures are one of the most common, and potentially serious, overuse injuries. A stress fracture is an incomplete fracture that can occur anywhere in the body, and are typically caused by repetitive forceful actions. In contrast, most other types of fractures are caused by a single, direct, traumatic impact.

Stress fractures usually occur in weight-bearing bones, and are commonly seen in the metatarsals of the foot, bones of the ankle, shins (tibia), knees, and hips (the neck of the femur is one the worst stress fractures). Stress fractures are often caused by repetitive activities such as running, dancing, soccer, or any sport that involves high levels of repetitive actions. Stress fractures can eventually lead to a complete fracture.

How the injury occurs

Your body is continually remodeling your skeletal system based on the stresses that are placed upon it. This remodeling process gives your body the ability to handle increased loads without further injury. The problem arises in that your body can only adapt to these stresses at a certain rate, and there is a finite limit to the amount of stress to which it can adapt. Injuries to the bone (microscopic fractures) occur when increased stress is placed upon your body too quickly, or when too much load is applied.

In more technical terms, stress fractures occur in the early stage of bone remodeling when osteoclastic reabsorbtion of bone, outstrips the osteoblastic development of new bone. This results in a weakened bone that is susceptible to injury. Osteoblasts and Osteoclasts control the amount of bone in your body:

· Osteoblast - Osteoblasts are cells which are responsible for bone formation. These cells produce osteoids, that are composed primarily of Type I collagen.

· Osteoclast – Osteoclasts remove bone (reabsorb bone) by removing its mineralized matrix and breaking up organic bone.

Two Common Types of Stress Fractures

· Low-Risk Stress Fractures– An athlete can often heal these injuries by reducing activity, focusing on cross-training, nutritional supplementation, and a programs of conservative care accompanied by appropriate rehabilitation exercises.

· High-Risk Fractures – These fractures often occur on the tension side of a bone. Typically, these type of stress fractures do not respond well to any weight bearing activities or stresses, and require a non-weight bearing cast or complete immobilization to heal. In advanced cases surgery may be required to complete the healing process. Typical high risk areas include: Medial malleolus, navicular bone, fifth metatarsal, and the femoral neck.

You will need to consult a qualified medical practitioner to determine if a stress fracture is high-risk or not.

In part two of Understanding Stress Fractures we will cover risk factors and diagnosis.

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